The use of questioning strategies by clinical teachers

Personalized Teaching Questioning Strategies Study Based on Learners' Cognitive Structure Diagnosis

Personalized education has been a widely shared goal pursued by Chinese and foreign educators. As the primary method of teacher-student interaction, the importance of personalized questioning is self-evident. Due to a lack of technical support, teachers rely on their teaching experience to ask questions without considering the learning situation of learners. This results in teaching questioning being unable to support learners' learning. These questions are relatively shallow and cannot promote the construction and transfer of learners' knowledge. Cognitive diagnostic technology could diagnose learners' cognitive states and provide services for personalized teaching. Therefore, a personalized teaching questioning strategy based on learners' cognitive structure diagnosis was proposed in this study. Firstly, we diagnosed learners' cognitive structure through usability, distinguishability, and stability. Secondly, we discussed the types of questions that teachers should raise when facing learners in different situations. We also discussed the application of personalized teaching questioning strategies. The experiment took place at M Primary School in Ningxia, China, with the participation of one teacher and ninety-seven fourth-grade students. Seven lessons were observed and videotaped across a range of topics. The study revealed that personalized teaching questioning strategies could improve learners' academic performance and subject literacy. They can also increase the number of teacher questioning, change the depth of teacher questioning content, and expand the scope of questioning subjects.

Questioning Aid for Rich, Real-Time Discussion (QARRD): A Tool to Improve Critical Thinking in Clinical Settings

Introduction

Critical thinking skills are crucial for health professionals, especially in clinical settings. However, most health professions educators engage learners with only lower-level concepts such as definitions, fact recall, or basic explanations. Employing strategic questioning methods that require learners to use higher-order thinking can help develop clinical reasoning skills.

Methods

The Questioning Aid for Rich, Real-time Discussion (QARRD) was created for health professions educators to purposefully implement concepts from Bloom's taxonomy and hierarchical questioning in clinical settings. The tool was introduced to faculty in a 1-hour, interprofessional workshop that described learning science and evidence-based questioning methods. Participants practiced QARRD questioning strategies and completed a pre/post case-based evaluation in which they developed discussion prompts for learners.

Results

Thirty-seven educators participated in two separate workshops. The majority (71%) of preworkshop prompts were lower-order thinking skills (remembering/understanding). After the workshop, the complexity of participants' discussion prompts increased significantly. Most postworkshop prompts (69%) reflected higher-level thinking skills (apply/analyze/evaluate/create). Many participants reported that, despite previously knowing about Bloom's taxonomy, they had not known how to implement this learning framework in clinical instruction until completing the QARRD training.

Discussion

The QARRD is a versatile, practical tool for health professions educators to practice promoting higher-level thinking in clinical settings. QARRD strategies allow educators to make small, purposeful adjustments to instructional methods that meaningfully engage learners to help facilitate clinical reasoning. This workshop can be delivered at other institutions and adapted as a virtual grand rounds to broadly enhance strategic questioning in clinical education.

Impact of supplemental individual verbal defense on confidence, engagement, and performance in a team-based learning therapeutics course

BACKGROUND AND PURPOSE

Team-based learning (TBL) has been successfully applied to multiple healthcare education disciplines. A primary tenet of TBL is the development of solutions leveraging the collective knowledge of a team rather than the individual competency of any one student. In an effort to enhance individual student accountability, an individual verbal defense (IVD) format was implemented in a multi-campus TBL-based pharmacotherapeutics course. The study sought to investigate the use of TBL-IVD embedded within a traditional TBL format on student engagement, teaching style preferences, and exam performance compared to a TBL-only format.

EDUCATIONAL ACTIVITY AND SETTING

In this cross-sectional study, second-year pharmacy students enrolled in a pharmacotherapeutics course during fall 2019 completed an 11-item survey. The survey was designed to assess TBL-IVD on student engagement and teaching style preference. Free-response qualitative feedback was solicited to assess positive-negative themes related to the activity. Aggregate exam performance for community-acquired pneumonia (CAP) related content was compared to historical exam data to assess the impact on student performance.

FINDINGS

The majority of students (72%, n = 54) preferred the TBL-IVD compared to a TBL-only format. Students reported higher engagement with TBL-IVD (84%, n = 63). Correct exam responses for CAP related content were higher in the TBL-IVD group (67% vs. 55%, P < .001). Positive themes included an increased opportunity to defend recommendations verbally and increased interaction with an on-campus faculty member.

SUMMARY

The study demonstrates the addition of IVD can enhance student perceptions, confidence, and performance within a large, multi-campus, TBL-based pharmacotherapeutics course.

How does questioning influence nursing students' clinical reasoning in problem-based learning? A scoping review

BACKGROUND

Problem-based learning is an educational method promoting clinical reasoning that has been implemented in many fields of health education. Questioning is a learning strategy often employed in problem-based learning sessions.

AIM

To explore what is known about the influence of questioning on the promotion of clinical reasoning of students in health care education, specifically in the field of nursing and using the educational method of problem-based learning.

METHODS

A scoping review following Arksey and O'Malley's five stages was conducted. The CINAHL, EMBASE, ERIC, Medline, and PubMed databases were searched for articles published between the years of 2000 and 2017. Each article was summarized and analyzed using a data extraction sheet in relation to its purpose, population group, setting, methods, and results. A descriptive explication of the studies based on an inductive analysis of their findings to address the aim of the review was made.

RESULTS

Nineteen studies were included in the analysis. The studies explored the influence of questioning on critical thinking rather than on clinical reasoning. The nature of the questions asked and the effect of higher-order questions on critical thinking were the most commonly occurring themes. Few studies addressed the use of questioning in problem-based learning.

CONCLUSIONS

More empirical evidence is needed to gain a better understanding of the benefit of questioning in problem-based learning to promote students' clinical reasoning.

Questioning skills of clinical facilitators supporting undergraduate nursing students

AIMS AND OBJECTIVES

To report on a study investigating questioning skills of clinical facilitators who support the learning of undergraduate nursing students.

BACKGROUND

The ability to think critically is integral to decision-making and the provision of safe and quality patient care. Developing students' critical thinking skills is expected of those who supervise and facilitate student learning in the clinical setting. Models used to facilitate student learning in the clinical setting have changed over the years with clinicians having dual responsibility for patient care and facilitating student learning. Many of these nurses have no preparation for the educative role. This study adapted a comparative study conducted over fifteen years ago.

DESIGN

Descriptive online survey including three acute care patient scenarios involving an undergraduate nursing student. Participants were required to identify the questions they would ask the student in relation to the scenario.

METHODS

A total of 133 clinical facilitators including clinical teachers, clinical educators and preceptors from five large partner healthcare organisations of one Australian university participated.

RESULTS

The majority of questions asked were knowledge questions, the lowest category in the cognitive domain requiring only simple recall of information. Facilitators who had undertaken an education-related course/workshop or formal qualification asked significantly more questions from the higher cognitive level.

CONCLUSION

The study provides some evidence that nursing facilitators in the clinical setting ask students predominantly low-level questions. Further research is needed to identify strategies that develop the capacity of facilitators to ask higher level cognitive questions.

RELEVANCE TO CLINICAL PRACTICE

Clinical facilitators should undertake targeted education that focuses on how to frame questions for students that demand application, analysis, synthesis and evaluation.

Questioning as a teaching tool

The Dreyfus and Bloom frameworks can help the great clinical teacher craft questions that are learner-centric and appropriately challenging.Employing strategies to ask the right questions in the right way can further add to the effectiveness of using questions as a valuable teaching,learning, and assessment tool.

Problems in the supervision and assessment of student nurses: Can clinical placement be improved?

The assessment and supervision of student nurses during clinical placement remains a complex activity. The student needs to be assessed thoroughly to identify his or her strengths and weaknesses. Further, this assessment should be conducted in circumstances which allow the student to be at his or her best. There are many which continue to impact upon clinical supervisors although documented over the last five to ten years. This paper addresses how assessment and student supervision are still influenced by extraneous factors. Its major suggestion is for universities to place a greater emphasis on all aspects of the clinical placement component within nursing courses.

Best practice strategies for effective use of questions as a teaching tool

Questions have long been used as a teaching tool by teachers and preceptors to assess students' knowledge, promote comprehension, and stimulate critical thinking. Well-crafted questions lead to new insights, generate discussion, and promote the comprehensive exploration of subject matter. Poorly constructed questions can stifle learning by creating confusion, intimidating students, and limiting creative thinking. Teachers most often ask lower-order, convergent questions that rely on students' factual recall of prior knowledge rather than asking higher-order, divergent questions that promote deep thinking, requiring students to analyze and evaluate concepts. This review summarizes the taxonomy of questions, provides strategies for formulating effective questions, and explores practical considerations to enhance student engagement and promote critical thinking. These concepts can be applied in the classroom and in experiential learning environments.

A comparison of student and faculty perceptions of clinical post-conference learning environment

The purpose of this study was to repeat a study by Letizia and Jennrich that described and compared perceptions of the clinical post-conference learning environment of undergraduate baccalaureate student nurses (BSN) and faculty. The Clinical Post-Conference Learning Environment Survey (CPCLES) was sent electronically to all traditional and accelerated BSN students and faculty; 178 usable responses were returned. Both faculty and students perceived the environmental characteristics captured by the CPCLES were important, but were used less than expected (p<0.025). No differences were found between faculty and students in perceptions of importance and actual use of the post-conference learning environment. Results showed highest scores for the subscale Teacher Support for both faculty and students. Lowest scores were received for Innovation. The results suggest the important role faculty has in supporting students' efforts to understand and find meaning in clinical experiences. Post-conference learning experiences could be enriched by faculty efforts to increase active learning strategies and innovative experiences. Further research is needed to determine effectiveness of new approaches to the post-conference in facilitating clinical reasoning among student nurses, and promote students' ability to provide safe, high-quality care.

Clinical judgment: the last frontier for evaluation

Nursing educators and preceptors often find it difficult to evaluate prelicensure students' clinical judgment development. Clinical judgment is critical to excellent patient care decisions and outcomes. The Lasater Clinical Judgment Rubric, a validated, evidence-based clinical judgment rubric, is described as a tool that offers a common language for students, nurse educators, and preceptors and a trajectory for students' clinical judgment development. The rubric has been used to provide feedback for reflective journals and a means for self-evaluation in addition to a guide for formulating higher level thought questions to shape students' thinking like a nurse.

Estratégias de ensino das habilidades do pensamento crítico na enfermagem

Objetivou-se caracterizar estratégias de ensino utilizadas na enfermagem para desenvolver habilidades do pensamento crítico. Elaborou-se uma revisão integrativa nas bases de dados Web of Science e Cumulative Index of Nursing and Allied Health Literature (CINAHL), com os descritores critical thinking, nursing e teaching, no período de 1987 a 2008. A amostra constitui-se de 64 artigos e a análise permitiu a identificação de 27 estratégias de ensino do pensamento crítico aplicadas na enfermagem. Dentre estas, as cinco mais citadas foram: questionamento, estudo de caso, ensino online e aprendizagem interativa, mapa conceitual e aprendizagem baseada em problemas. Diferentes estratégias reveladas neste estudo evidenciam uma gama de possibilidades que poderão ser aplicadas no ensino e na prática clínica. Conclui-se que o desenvolvimento de habilidades do pensamento crítico por meio destas estratégias pode proporcionar a formação de profissionais mais críticos e reflexivos.

Problem based learning - 'Bringing everything together' - A strategy for Graduate Nurse Programs

This article discusses a case study that was initiated by a Graduate Nurse Coordinator of an acute care inpatient hospital in Australia. It outlines the conceptualisation and creative implementation of a structured group problem based learning activity which was a component of a Graduate Nurse Program. The learning activity was based on the beliefs that knowledge acquisition today is an active process and should focus on the learner developing strategies to obtain, review and manage information. The learning activity implemented in this case study was valuable as it recognised the benefits that can be gained for the Graduate Nurse by ensuring the context of their teaching and learning activities is grounded in practical experiences. The learning activity aimed to prepare Graduate Nurses to cope with the multiple challenges faced as they enter the nursing profession by enhancing their skills of inquiry, problem solving and reasoning. The evaluation of this case study found that the incorporation of structured group problem based learning did promote the achievement of these educational outcomes with Graduate Nurses displaying critical thinking, clinical judgment and knowledge acquisition skills. An unexpected benefit of this activity for Graduate Nurses was the enhancement of clinical practice behaviours, such as communication and interactive skills. This case study describes the positive outcomes not only for Graduates Nurses in the application of their learning but also the wider benefits which can be gained for the organisation, patient care standards and the health care team. It is anticipated that this article will be an inspiration to others who are interested in implementing innovative teaching strategies into Graduate Nurse Programs.

Questioning skills demonstrated by approved clinical instructors during clinical field experiences

CONTEXT

The current trend in athletic training clinical education places greater emphasis on the quality of interactions occurring between Approved Clinical Instructors (ACIs) and athletic training students (ATSs). Among other attributes, the ability of ACIs to facilitate and direct quality clinical learning experiences may be influenced by the skill with which the ACI is able to use selected teaching strategies.

OBJECTIVE

To gain insight into ACIs' use of questioning as a specific teaching strategy during the clinical education experiences of undergraduate ATSs.

DESIGN

Qualitative case study design involving initial and stimulated-recall interviews, prolonged field observations, and audio recording of ACI-ATS interactions.

SETTING

The primary athletic training facility at one athletic training education program accredited by the Commission on Accreditation of Athletic Training Education.

PATIENTS OR OTHER PARTICIPANTS

The 8 ACI participants included 3 full-time athletic training education program faculty members and 5 graduate-level assistants. The 24 ATS participants included 1 senior, 17 juniors, and 6 sophomores.

DATA COLLECTION AND ANALYSIS

Transcribed data collected from 8 initial interviews, 23 field observations, 23 audio-recorded ACI-ATS interactions and 54 stimulated-recall interviews were analyzed through microscopic, open, and axial coding, as well as coding for process. The cognition level of questions posed by ACIs was analyzed according to Sellappah and colleagues' Question Classification Framework.

RESULTS

The ACI participants posed 712 questions during the 23 observation periods. Of the total questions, 70.37% were classified as low-level cognitive questions and 17.00% as high-level cognitive questions. The remaining 12.64% were classified as other.

CONCLUSIONS

Although all ACIs used questioning during clinical instruction, 2 distinct questioning patterns were identified: strategic questioning and nonstrategic questioning. The way ACIs sequenced questions (their questioning pattern) appeared to be more important than the number of specific cognitive-level questions posed. Nonstrategic questioning appears to support knowledge and comprehension, whereas strategic questioning appears to support critical thinking.

Conducting clinical post-conference in clinical teaching: a qualitative study

AIM AND OBJECTIVE

The aim of this study was to explore nurse educators' perceptions regarding clinical postconferences. Additional aims included the exploration of interaction characteristics between students and faculty in clinical postconferences.

BACKGROUND

Nursing students are challenged to think and learn in ways that will prepare them for practice in a complex health care environment. Clinical postconferences give students the opportunity to share knowledge gained through transformative learning and provide a forum for discussion and critical thinking. Faculty members must guide students as the latter participate in discussions, develop problem-solving skills and express feedings and attitudes in clinical conferences.

METHODS

The study used qualitative research methods, including participant observation and an open-ended questionnaire. Participant observers watched interaction activities between teachers and students in clinical postconferences. A total of 20 clinical postconferences, two conferences per teacher, were observed. The Non-Numerical Unstructured Data Indexing Searching and Theory-building qualitative software program was used in data analysis.

CONCLUSIONS

Research findings indicated that, of the six taxonomy questions, lower-level questions (knowledge and comprehensive questions) were mostly asked by faculty members' postclinical conferences. The most frequently used guideline was task orientation, which is related to practice goals and was found in discussions of assignments, reading reports, discussions of clinical experiences, role plays, psychomotor skill practice, quizzes and student evaluations.

RELEVANCE TO CLINICAL PRACTICE

It is an essential responsibility of nurse educators to employ postconferences to assist students in applying their knowledge in practical situations, in developing professional values and in enhancing their problem solving abilities.

Video as a Strategy to Evaluate and Assist Clinical Teachers With Student Assessment

The assessment of the clinical competence of nursing students requires expertise in nursing as well as skills in student assessment. The development of these student assessment skills is dependent on the preparation of the clinical teacher. The results of this pilot study indicate that video can be one successful tool in evaluating the assessment skills of clinical teachers. Video also may be useful as a staff development tool by providing a nonthreatening way for clinical teachers to familiarize themselves with clinical assessment. In turn, this will have benefits for universities and students by ensuring consistency of clinical assessment by clinical teachers.

Questioning: A tool in the nurse educator’s kit

Effective questioning is one of the most important teaching techniques and plays a crucial role in creating an effective learning environment. Yet, in nurse education little has been written about this technique or its importance. Most literature refers to the need for lecturers to be skilled in questioning, but less is written about how to develop this essential technique. Being skilled in questioning is an important fundamental step towards becoming an effective lecturer. Developing the skills necessary to help students draw on and apply acquired knowledge in new, unique situations requires the skilled use of questioning. Most experienced lecturers use both written and verbal questioning, but evidence suggests that the majority of their questioning is posed at lower cognitive levels of description. Quality teaching requires students to be engaged with the content of learning tasks designed to reach understanding. Using questioning appropriately facilitates the learning process by requiring the student to participate in the process and to achieve higher comprehension skills by acquiring deep, elaborate understanding of the subject. To acquire and develop this skill, the lecturer is required to understand questioning, to select the tool appropriately and to use questions that are varied, planned, appropriate and humanely posed. The functions of questioning, types of questions and the key skills required for the effective use of this teaching strategy are outlined in this article.

An analysis of clinical teacher behaviour in a nursing practicum in Taiwan

AIM AND OBJECTIVES

The aim of this study was to identify and assess the teaching behaviours (knowledge, attitudes and skills) observed in nurse educators as they taught in the clinical setting.

BACKGROUND

Many quantitative studies have defined and evaluated teaching effectiveness in the clinical area. Some of these studies established instruments to evaluate faculty effectiveness in the clinical setting; however, they tended to be so broad that they were of limited use in understanding clinical teaching behaviours in nursing education.

DESIGN

This study explored clinical teaching behaviours in a nursing practicum. Ten nurse educators taught 10 students in the medical-surgical unit at a hospital in Taiwan for about four weeks. Each teacher was observed by the researcher and one other observer for two days during regularly scheduled clinical teaching time.

METHODS

Data collection and analysis were done by a qualitative approach. Content analysis is a process of identifying, coding and categorizing the themes in the data.

CONCLUSION

The themes of clinical teaching that emerged from data analysis included teaching aims (task-oriented and learner-centred), teacher competence (teacher knowledge, instructional strategies, planning learning experience, teaching priorities, feedback and caring) and teaching commitment (professional identity and giving of self). These findings offer a holistic blueprint of clinical teaching for nursing faculty members, which will enhance the quality of nursing education.

RELEVANCE TO CLINICAL PRACTICE

Complexity in nursing education has increased as it is challenged to meet the needs of diverse populations in rapidly evolving and highly technical health-care settings. Clinical teachers must be enabled and empowered to provide students with appropriate knowledge and skills to meet the needs of patients. To develop students' professional nursing identity now and in the future, nurse educators have to commit themselves to both nursing and teaching in clinical settings. More nurses need to be prepared for careers in education at the master's and doctoral levels.

Critical Thinking: Back to Square Two

Tracking the development of critical thinking in students presents challenges for nursing programs. After 8 years of measuring critical thinking with mixed results, faculty at one school analyzed current beliefs and practices with a focus on the type of thinking that is reinforced in both classroom and clinical settings and the effects of classroom technology on critical thinking. Recommendations for the conceptualization of critical thinking and its measurement, as well as teaching strategies to emphasize principles over "coverage," are proposed.

Strategies to Scaffold Student Learning

Teaching strategies like modeling, feedback, questioning, instructing, and cognitive structuring are applications of Vygotsky's Zone of Proximal Development. These strategies "scaffold" student learning from assistance by others to self-learning toward the goal of internalization. This higher-order learning stems from interactions with those who have more knowledge than the learner. Practical applications of Vygotsky's theory to any basic nursing education program are presented.

Faculty perceptions of critical thinking in student clinical experiences

Critical thinking is an essential skill for nurses who practice in complex health care systems. This study explored nursing faculty members' perceptions of teaching critical thinking to baccalaureate student nurses in clinical settings. Six clinical faculty members were interviewed using an ethnographic approach. Findings focus on two domain analyses that describe the nature of critical thinking and strategies to effectively teach it. Faculty members conceptualized critical thinking as "putting it all together" through information seeking, reflecting, assigning meaning, problem solving, predicting, planning, and applying information. Faculty members perceived that they teach critical thinking through a number of approaches that include asking questions, reviewing written products, conducting clinical conferences, and evaluating student journals. The findings of this study have implications for faculty who seek a clearer definition of critical thinking in nursing and a rich description of strategies to teach this skill.

The questioning skills of tutors and students in a context based baccalaureate nursing program

This paper explores, describes and compares the types and levels of questions asked by 30 randomly selected tutors (nurse educators) and their 314 students in context-based learning tutorial seminars in a Canadian baccalaureate nursing program. Thirty 90-min seminars were audio taped, transcribed and coded using a Questioning Framework designed for this study. The framework includes types and levels of questions, related wording and examples. The results of this study indicate that the majority of questions asked by tutors and students in the first three years of the program were framed at the low level (knowledge, comprehension, and application) and were aimed at seeking yes/no responses and factual information more so than probing. Although these questions are important to facilitate the teaching/learning process, educators and students need to increase the number of questions requiring analysis, synthesis, and evaluation as well as questions that involve probing, exploration, and explanation - questions believed to activate and facilitate critical thinking skills. Recommendations include the need for students and tutors to be taught how to question, the creation of a supportive environment for questioning and the use of appropriate strategies to teach the use of higher order questions. Future research using a cross sectional longitudinal design and qualitative approaches are also recommended. This study has direct implications for enhancing student learning and the development of nurse educators.

Preceptor questioning and student critical thinking

Questioning is fundamental to student learning. Not only does it enable students to elevate their level of thinking, but in the process it also affords them the opportunity to deal with their world intelligently. The practice setting is an environment rich in opportunity for enabling critical thinking through the use of questioning. In the preceptorship experience, preceptors are in a prime position to use questioning behaviors that can challenge the way preceptees think, encourage them to justify or clarify their assertions, promote the generation of original ideas, explanations, or solutions to patient problems, provide mental and emotional tools to help resolve dilemmas, promote discussion, and evaluate learning. This article discusses the importance of preceptor questioning for the development and promotion of student critical thinking. Contextually, the authors draw on the findings of a recent study in which preceptor questioning of the knowledge base, decision making, and actions of the preceptee were found to directly bring about or trigger their critical thinking. This article allows for some further reflection on that process and its contribution to the enhancement of the preceptorship experience.

Critical thinking in nursing education: literature review

The need for critical thinking in nursing has been accentuated in response to the rapidly changing health-care environment. Nurses must think critically to provide effective care while coping with the expansion in role associated with the complexities of current health-care systems. This literature review will present a history of inquiry into critical thinking and research to support the conclusion that critical thinking is necessary not only in the clinical practice setting, but also as an integral component of nursing-education programmes to promote the development of nurses' critical-thinking abilities. The aims of this paper are to: (i) review the literature on critical thinking; (ii) examine the dimensions of critical thinking; (iii) investigate the various critical thinking strategies for their appropriateness to enhance critical thinking in nurses; and (iv) examine issues relating to the evaluation of critical-thinking skills in nursing.

The questioning skills of clinical teachers and preceptors: a comparative study

AIM OF THE STUDY

The purpose of this study, conducted as partial requirement for a Master of Nursing Studies Degree, was to explore, describe and compare the level of questions asked by clinical teachers and preceptors.

BACKGROUND

Questioning is one of many teaching/learning strategies thought to facilitate the development of critical thinking skills which are integral to nursing practice. As such the type and number of questions asked have implications for student learning. Currently in Melbourne, Australia, many undergraduate nursing degree courses utilize both clinical teachers and preceptors to facilitate student learning in the clinical setting.

DESIGN

A comparative descriptive design was used. Participants were given three acute care patient scenarios involving an undergraduate nursing student, as part of a questionnaire, and asked to identify the questions they would ask the student in relation to the scenario.

FINDINGS

Data revealed that the clinical teachers had considerably more years of experience in their role and higher academic qualifications than did the preceptors. The clinical teachers also asked a greater number of questions overall and more from the higher cognitive level. Despite this, the findings suggest that both clinical teachers and especially preceptors need to increase the number of higher level questions they ask.

CONCLUSIONS

Based on the findings of this study, it is evident that there is a need for further comparative studies into the questioning skills of clinical teachers and preceptors. Also, these two groups require education about the importance of higher level questioning for student learning as well as how to ask questions generally.